Parents Find 'As-Needed' Posthospital Care for Bronchiolitis Noninferior to Scheduled Visits

By Lisa Rappaport

July 08, 2020

(Reuters Health) - Parents of children hospitalized for bronchiolitis find follow-up care on an as-needed basis noninferior to scheduled visits, a clinical trial suggests.

The primary endpoint of the open-label noninferiority trial was parental anxiety seven days after discharge for children younger than 24 months hospitalized for bronchiolitis. A total of 304 children were randomly assigned to receive scheduled follow-up visits or follow-up visits only on an as needed basis.

Researchers assessed parental anxiety using the Hospital Anxiety and Depression Scale, with higher scores between 0 and 28 indicating greater anxiety levels. The mean seven-day score was 3.9 among parents in the as-needed follow-up group and 4.2 in the scheduled group.

These results have broad implications for healthcare utilization, said lead author Dr. Eric Coon, an associate professor of pediatrics at the University of Utah School of Medicine and Intermountain Primary Children's Hospital in Salt Lake City.

"Approximately 10,000 children are discharged from a hospital each day in the U.S. excluding newborns, and the vast majority receive instructions to automatically schedule a follow-up visit for a few days after they go home," Dr. Coon said by email. "Our findings should prompt medical providers to consider whether a scheduled follow-up visit is always necessary."

Overall, 106 children (81%) in the scheduled follow-up group and 26 children (19%) in the as-needed group had a posthospitalization visit, researchers report in JAMA Pediatrics.

The median time from discharge to follow-up visit was three days, and 103 of these visits occurred with the patient's primary care provider.

Despite the dramatic difference in follow-up visits, researchers didn't find any significant differences between the as-needed and scheduled follow-up groups in secondary study outcomes including readmissions (2.2% vs 3.8%); emergency department visits prior to symptom resolution (5.8% vs 3.8%); number of clinic visits before symptom resolution (0.7 for both groups); or mean time from discharge to symptom resolution (7 days vs 8.7 days).

One limitation of the study is that researchers didn't standardize the posthospitalization visit, and providers may vary in how they handle follow-up care, the study team notes.

Results also may not be generalizable to all children with bronchiolitis because the study excluded kids with serious comorbidities and children for whom a doctor specifically ordered follow-up.

Ideally, clinicians should use their best judgement about whether a child hospitalized with bronchiolitis may need a follow-up visit, said Dr. Jay Berry of Boston Children's Hospital and Harvard Medical School, who coauthored an editorial accompanying the study.

"Don't just assume that all children need it," Dr. Berry said by email. "That assumption may lead to overuse of health services without improving quality of care."

Instead, clinicians should think about which children might have health or other issues after discharge that necessitate post-discharge follow-up, Dr. Berry said.

"Focus discharge planning efforts on those children," Dr. Berry added. "Make sure they have appropriate follow-up to optimize their health and safety."

SOURCE: https://bit.ly/38IkNBi and https://bit.ly/38CiOhM JAMA Pediatrics, online July 6, 2020.

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